Nhyira FM’s investigation reveals conflicting information about some health conditions for which the Komfo Anokye Hospital no more accepts National Health Insurance.

While authorities list 43 ailments to be exempt from the scheme, NHIS tally cards indicate otherwise.

The Cash and-Carry system which was ‘abolished’ following the introduction of the National Health Insurance Scheme, appears to have resurfaced at the hospital.

Scheme card-bearing patients are now required to pay for certain services hitherto covered by the scheme.

Disappointed subscribers have been quarreling with doctors and nurses for denying them access especially to the Surgical Department.

Doctors and the nurses are said to be operating on the instructions of the KATH Chief Executive Officer, Professor Ohene Agyei.

Nhyira News has sighted a memo dated 7th July, 2011, and signed by the CEO addressed to all heads of directorates and units, to that effect.

It states ‘with immediate effect, all NHIS card holders who are treated for 43 conditions will have to pay for such services.”

Some patients have questioned the decision when they had in the past been treated for such ailments for free under NHIS.

Adams Razack arrived at the hospital as usual with his NHIS card for a review of his hernia condition only to be told he could not be attended to by doctors at the Surgical Department.

He had to borrow money from a friend to enable him to receive care.

“We made noise in protest over the cash and carry system. I have never been asked to pay cash here but they demanded money today before attending to me. Though I had GGS5 on me, it was not enough”, Razack explained.

Many others who had come from outside the Ashanti Region shared similar sentiments.

“We always come here with insurance cards. But they asked us to pay cash today or we go home. I was told officials of Komfo Anokye Teaching Hospital took that decision. I paid GHS12 before they (doctors) attended to me. Government should intervene and save us” said a patient from Enchi in the Western region.

Hospital authorities however say they cannot be blamed for their decision to demand cash payment from NHIS subscribers before treatment.

Public Relations Officer, Kwame Frimpong told Nhyira FM National Health Insurance Authority has failed to pay claims on the 43 conditions.

“There is a tariff list. It indicates the various medical conditions under which the hospital was obliged under its contract with the National Health Insurance Authority to render services to the subscribers of NHIS so we base the billing processes on the tariff. If the condition is not outlined in the tariff, then you are expected to pay cash. In this particular instance, we have documentary evidence to prove that those conditions that our attention has been drawn to by the authorities (NHIA) that we shouldn’t have seen patients under the health insurance are on the tariff list that was given to us”.

According to Mr. Frimpong, the situation has led the hospital to accumulate debts and ponder over the NHIA refusal to pay claims.

“The tariff list has these medical conditions listed as being qualified for treatment under the National Health Insurance.
For instance, if you take tumour of facial bones and soft tissues, the tariff in the ICD-10 code (International Classification of Disease) for this disease is D48.0. If you take Benign Neoplasm of Ovary, it is D27, if you take Benign Neoplasm of the Uterus, its D26.9. These are the codes on the tariffs and which indicate that we could submit bills in respect of these medical conditions to the authorities for payment.

And this is what we have been doing for some time now”, he explained.

Story by: Ohemeng Tawiah, Nhyira FM/Ghana